An 11 yo M with no PMH presented with 2 days of intermittent RLQ pain which migrated to periumbilical area.  Some vomiting of remainder of ROS is negative.  Patient was awaiting formal ultrasound of appendix.  A bedside FAST exam was performed.  This demonstrated asymmetry between the right and left kidney.  Bedside ultrasound focusing on the kidneys demonstrated an enlarged collecting system of the kidney.  With color Doppler, one can appreciate the presence of vessels at the renal pelvis and right next to it, the enlarged collecting system suggestive of hydronephrosis.

Upon further questioning, a family history of nephrolithiasis was obtained.  These findings were communicated to the primary providers who ordered a formal abdominal ultrasound.  The final radiology report stated that there was mild-moderate R hydronephrosis and that a recently passed renal calculus was a consideration.